Bone marrow transplant

Bone Marrow Transplantation

Bone marrow transplantation is the surgical process performed to replace destroyed and diseased bone marrow with healthy bone marrow stem cells from a donor. The procedure involves extracting the bone marrow which contains normal stem cells from the healthy donor and replacing it in the patient. The transplant aims to reproduce the patient’s blood cells to cure disease and built immunity.

Bone marrow is sponge-like tissue. It is found within the central hollow of the long bones. It contains stem cells which produce new blood cells.

Types of Bone Marrow Transplant:

  • Autologous bone marrow transplant- The patient’s own stem cells are taken before radiation or chemotherapy
  • Allogeneic bone marrow transplant- Stem cells are taken from the donor who is usually a close family member of the patient, or another matching donor
  • Umbilical cord blood transplant-  Stem cells from the umbilical cord are taken, immediately after the birth of the infant.

Advantages and Disadvantages

Advantages

  • After transplantation, the donor’s marrow reaches the patient’s bone cavity to produce a normal quantity of healthy blood cells
  • Extends the patient’s life and improves life quality

Disadvantages

  • The risk to develop Graft –Versus- Host disease
  • Growth of children may be delayed after transplant

Why is it needed?

Bone marrow transplants are prescribed when the patient’s body is unable to produce blood cells, in conditions like:

  • Cancerous conditions – lymphoma, leukemia, and multiple myeloma
  • Diseases like
    • Sickle cell anemia
    • Thalassemia
    • Aplastic anemia
    • Severe immunodeficiency syndromes
    • Congenital neutropenia
  • Destruction of the bone marrow because of chemotherapy used to treat some cancers and Hodgkins disease.

Facts and figures

  • E. Donnel Thomas first theorized transplanting bone marrow. He received Nobel Prize in Physiology-Medicine
  • Minnesota University’s Robert A. Good performed first allogeneic transplantation (successful)
  • National Bone Marrow Donor Registry / National Marrow Donor Program was founded in 1986. More than 4 million donor volunteers provide services in approx. 14 countries

Pre-operative and Post-operative Care

Preoperative preparation

  • Full-body physical examination
  • Blood test, liver and kidney function tests
  • Urinalysis
  • USG of the abdomen, CT scan
  • Relatives and patient are informed regarding the procedure, including risks and follow up care
  • Surgeon consultation week before to ascertain medicine required and medicines stopped
  • Have an arrangement with family and/or friends for help after surgery
  • Arrangement of blood transfusion, if required during or post-surgery
  • Preparation of  home as required for recovery after surgery
  • Do not drink or eat post after midnight, the night before surgery
  • Medical tourist is advised to plan maximum time for a trip
  • Up to 2 catheters are inserted to large blood vessels before transplantation to receive fluids, treatment etc

Post operative care

  • Usually, 6-4 weeks of hospital stay is prescribed post-surgery. Vital signs are monitored and medication is given to avoid infection.
  • Some patients require a blood transfusion.
  • Intravenous fluids are given till diarrhea, mouth sores and nausea are cleared.

Engraftment

  • Engraftment is the process when bone marrow is accepted by the patient’s body. A regular blood count is taken to monitor engraftment.
  • Full recovery can happen within 3-6 months.